Provider Demographics
NPI:1437979275
Name:RIDGEWAY, EILEEN ANN I
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANN
Last Name:RIDGEWAY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-2011
Mailing Address - Country:US
Mailing Address - Phone:518-447-7000
Mailing Address - Fax:
Practice Address - Street 1:175 GREEN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-2011
Practice Address - Country:US
Practice Address - Phone:518-447-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3029101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)